If you’re a TPA leader, working with several vendors to process claims can be like the proverbial herding of cats. TPAs bear the responsibility of managing inquiries, appeals, billing disputes and ensuring accuracy — as well as the mounting pressure to deliver it all faster. Working with multiple vendors might solve the issue of timely claims management but it creates a different challenge — operational complexity.
Fear not — there is a way to bring order to claims chaos.
TPAs can simplify claims management, reduce vendor sprawl and enable smarter scaling by looking to unified platform solutions.
How does managing multiple vendors affect TPA operations?
Vendor sprawl occurs when TPAs rely on multiple point solutions to process claims. While a common approach, it can create operational inefficiencies, increase IT and administrative burdens and introduce compliance risks. Managing many vendors also tends to slow claims processing and limits scalability, impacting both performance and client satisfaction.
The effects of vendor sprawl on claims processing speed and accuracy
Disconnected systems require manual handoffs and reconciliation, making it harder to deliver consistent, accurate and defensible outcomes.
So, how do you know if vendor sprawl is to blame?
Here are a few signs that vendor sprawl is affecting your operations:
- Fragmented workflows
- Manual handoffs
- Increased error rates
- Slower claims turnaround
- Data silos
- Inconsistent results
The hidden costs of managing multiple vendors
The hidden costs include increased IT and administrative workload, integration challenges and compliance headaches. Fragmentation also makes it harder to scale operations and respond to regulatory changes.
Common frustrations for plans include IT resource drain, custom configuration needs and increased compliance complexity.
How can TPAs simplify claims management?
TPAs can simplify claims management by consolidating vendors and adopting a centralized, modular platform approach. This reduces the need for multiple integrations and custom configurations, streamlines workflows and enables phased adoption without disrupting existing operations.
Think one contract, one support team, one platform.
Guiding principles toward smarter scaling
1.Start with visibility
Map your claims lifecycle and identify fragmentation. Unified platforms offer a single view, making inefficiencies easy to spot.
2. Design for interoperability
Don’t rip and replace—connect the dots. Platforms that integrate with existing tools orchestrate workflows rather than replacing them.
3. Activate intelligence, not just automation
Automation is good; intelligence is better. Platforms that combine AI-powered routing with human oversight deliver accuracy, transparency and adaptability.
A solution for TPAs seeking simplicity and savings
TPAs operating in a competitive space need tech innovation and client-centricity.
The right unified platform can deliver:
- Cost reduction viaconsolidatedclaims processing
- Simplified operations with modular scalability
- Regulatory compliance through expert-validated decisions
- Revenue growth via longitudinal insights and optimized pricing
Why should TPAs consider a unified platform approach?
A unified, modular platform can help TPAs optimize claims across diverse clients, automate pricing and integrity workflows and deliver consistent, accurate recommendations that drive savings and strategic value.
Unified platforms can offer:
- Automated adjudication, reducing manualerrorsand speeding up claims.
- Real-time data sharing and centralized access, improving visibility and audit readiness.
- Cost savings through streamlined workflows and reduced vendor overhead.
- Scalability and modular adoption, allowing TPAs to grow without adding complexity.
Ready to scale smarter?
Learn how the Zelis Intelligent Pricing Platform (ZIPP) can help you scale cost containment without scaling complexity.
